【摘要】 目的：评价应用神经导航下经口鼻蝶入路手术的精确性，探讨避免或减少误差的措施。方法：12例鞍内占位患者术前均行2 mm层厚MRI扫描。于导航计算机工作站行三维重建。经口鼻蝶入路手术，手术中导航探头指引。结果：依术中切除肿瘤情况判定。本组12例，9例定位明确，3位偏差，误差率25%。结论：神经导航在经口鼻蝶入路手术中起到重要的辅助作用，但医生的技术和经验及避免依赖思想是避免误差的关键。
【关键词】 神经导航; 口鼻蝶入路; 误差; 定位
Analysis the declinational reasons of trans-oral-nasal-sphenoidal
approach using neuronavigation
WU Qin-fen, ZHANG Shi-zhong, ZHANG Wen-de
(Department of Neurosurgery, The No 474 Hospital of PLA， Urumqi 830011， China)
Abstract: Objective: To evaluate the accuracy of trans-oral-nasal-sphenoidal approach using neuronavigation and to investigate the measures of avoiding or decreasing error. Methods: Twelve patients with intrasella occupying lesion were scanned with 2 mm layer by MRI preoperative. There were three-dimensional reconstruction in navigation computer workstation. All patients underwent trans-oral-nasal-sphenoidal approach operation. We were guided by navigation probe in the operation. Result: Basing on the condition of excisional tumor, among 12 cases, 9 cases were precise location, 3 cases were declinational location. The error rate was 25%. Conclusion: Neuronavigation is helpful to trans-oral-nasal-sphenoidal approach. The technology and experience of surgeon and the avoidance of dependence are critical to the avoidance of error.
Key words: neuronavigation; oral-nasal-sphenoidal approach; error; location
神经导航技术为准确地探察脑内占位病变，尽可能地为切除肿瘤提供了保障。神经导航技术降低了术后并发症，使手术效果明显提高。但是，在神经导航手术中仍存在误差。我科自2001～2003年，应用stealth station神经导航系统施行经口鼻蝶入路鞍内占位显微外科切除术12例，总体效果满意，现报道如下。
1 资料与方法
1.1 一般资料 男性7例，女性5例，年龄10～62岁，平均34.4岁，病程3周至5年，根据影像学检查(CT及MRI)及激素水平测定，判定肿瘤性质大小：垂体腺瘤10例，rothkee囊肿2例。10例垂体腺瘤中泌乳素型(PRL)6例，生长激素型(GH)2例，混合性2例;10例垂体腺瘤中微腺瘤(1 cm)4例，大腺瘤(1～2 cm)4例，巨大腺瘤(2～3 cm)2例;rothkee囊肿2例中1例 1 cm，1例 1～2 cm，此2例激素水平正常。临床表现：视力障碍、视野缺损5例，头痛5例，肢端肥大2例，泌乳6例，闭经4例，性功能减退6例。
1.2 神经导航系统[1] 采用美国Sofamor Danek公司的Stealth Station导航系统，包括定位工具如嵌有能发射红外线的二极管(infrared lighting-emitting
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